Standards of Care

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Standards of Care

KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTRE

NURSING AFFAIRS (IN COLLABORATION WITH CLINICAL SERVICES)

STANDARDS OF CARE FOR PATIENTS ACCESSING SERVICES IN THE

AMBULATORY CARE SETTING

Clinic Name: Oncology Clinic

I. Patient Assessment/Patient Problems:

A. The patient can expect that his/her health status will be assessed in a holistic and comprehensive manner and documented throughout his/her association with the health care system.

1) Every patient receives a brief assessment by a nurse within 30 minutes of registering at the appropriate Ambulatory Care Clinic.

1.1 Basic Physical Structure.

1.2 Focus Assessments

1.2.1 Neurological function for:

(a) Patients on vinca alkaloid chemotherapy

(b) Patients with brain metastasis

1.2.2 Cardiovascular function for:

(a) Patients receiving anthracyclines

(b) Patients with cardiac problems prior to chemotherapy and complex diagnosis

1.2.3 Respiratory function:

(a) Patients receiving treatment associated with pulmonary toxicity and fibrosis such as

Bleomycin, CCNU, and Chlorambucil.

(b) Patients at risk for respiratory depression associated with some treatments.

chemotherapy treatment.

(d) Patient with pulmonary metastasis.

1.2.4 Integumentary/Musculosketal status:

(a) Patients at risk for skin reaction such as extravasation, rash, hives and flares from

chemotherapy.

(b) Patients at risk of developing skin discoloration associated with 5fu and hydroxyurea.

(d) Patients who complain of muscle weakness and pain.

1.2.5 GI/GU Status:

(a) Patients with nausea and vomiting

(b) Patients at risk for GI/GU infections due to neutropenia associated with chemotherapy

drugs.

(d) Patients at risk for constipation and diarrhea.

1.2.6 Patients at risk for developing renal toxicity.

2) Ambulatory Care Initial Visit/Annual Review form to be completed on every patient at initial

appointment in Ambulatory Care and annually thereafter for patient status review purposes

or as indicated by assessment of patient.

3) Ambulatory care Follow Up Visit form to be completed on every patient for all subsequent

appointments. In the Treatment Areas a Chemotherapy and Treatment Record chart will be

completed on every patient.

4) A detailed assessment will be performed prior to procedures involving anesthesia and/or

conscious sedation. Procedural sedations are used mainly for Pediatric patients for

Bone Marrow Aspiration and Lumbar Puncture. Any procedures requiring conscious

sedation will only be performed in the Treatment Areas. Conscious Sedation Flow sheet

must be completed on every patients requiring procedural sedation.

5) Vital signs will be taken on all patients at initial appointments in Ambulatory Care and

as dictated by Clinic Specific Standards of Care at follow up visits. For Patients receiving

chemotherapy, height, weight, calculation of Body Surface Area and verification of

lab values will be completed as required.

6) Pain level will be assessed at every visit.

7) Immunization status will be assessed at Initial and Annual Review Visits. For patients receiving

immunization post BMT procedure, appropriate immunization protocol will be followed and

documented on Immunization Record form 605-10 (Rev. 12-11)

8) Allergies will be updated at every visit.

9) Medication list will be reviewed and updated at every visit.

10) High Risk Screening will be completed at the initial visit, annually and as indicated.

Referrals may be made at any time by a physician.

B. The patient can expect that his/her health data is collected and analyzed by the interdisciplinary healthcare team and used to guide the planning of care.

1) Reassessment of patients occurs as follows:

1.1 If change in presenting status occurs.

1.2 Patient assessed as having unstable vital signs and/or life threatening condition will be

accompanied by a SNI/SNII to the area designated by the clinic physician or as appropriate

for patient’s condition.

1.3 During current visit

1.3.1 Post treatment procedure (i.e. post chemotherapy, post lumbar puncture, bone marrow

aspiration.)

1.4 Follow up visit to determine:

1.4.1 Response to treatment

1.4.2 Plan for continued treatment or discharge from system

1.4.3 Continuing health care needs, and if so, plan of care is revised accordingly

II. Patient Care Planning:

A. The patient can expect that their care requirements are assessed, planned, implemented and evaluated in

a systematic way.

1) An interdisciplinary written plan of care is formulated, implemented, evaluated and revised as needed

by the interdisciplinary team.

B. The patient’s plan of care is revised when indicated by a change in the patient’s condition or when

patient’s needs change.

C. The patient can expect that the plan of care promotes continuity of care.

1) All care provided by the interdisciplinary health care team shall be clearly documented in the

patient’s record and available to all health disciplines.

D. The patient/family can expect to have an opportunity to participate in the care process.

III. Psycho Social/Cultural/Religious Needs of the Patient:

A. The patient/family can expect support for their psychosocial, cultural, and religious well-being using the

following interventions:

1) Upon request, referrals to Social Services and/or Patient Relations may be made for appropriate

support.

2) Inform patients of their rights in a language and method they will understand.

3) Identify, protect and promote patient rights in the following ways:

(a) Utilizing translators and bilingual staff when necessary to enhance communication.

(b) Maintaining privacy during delivery of care (patient exam rooms, assessment rooms, waiting areas).

(c) Ensure confidentiality, written, verbal and electronic.

(d) Explaining tests and procedures before occurrence.

(e) Providing an environment that allows the patient/family to practice their cultural religious beliefs.

(prayer rooms separate waiting rooms).

(f) Coordinate with other departments including, but not limited to Patient Relations, Social Services

and other specialties as indicated.

IV. Patient Safety Needs:

A. The patient can expect that infection control and prevention measures be implemented according to

Hospital Infection Control policies.

1) Nursing care is provided according to Infection Control Policies and Procedures. Patients with infectious/ communicable disease such as chicken pox or herpes zoster are advised not to come to Oncology Clinic as the majority of our patients are severely immuno-compromised. Patients are advised to be seen in DEM for assessment and treatment if necessary.

2) Patients, families and sitters are given pertinent information regarding infection control and

personal hygiene as it applies to them.

B. The patient can expect that safety needs are addressed.

1) Patients will be correctly identified prior to any treatment, procedure or any dispensing of

medications.

1.1 All patients in the Treatment Areas must have an identification wristband applied prior to any treatment.

2) Informed consent is obtained according to policy.

2.1 Consent form for chemotherapy (Form 30500-22(05-21)) will be completed.

3) Providing environmental safety measures by ensuring that:

(a) The patient is properly secured on stretcher, in wheelchair, or reclining chair

(b) Electrical outlets are covered in pediatric areas (including treatment areas and waiting rooms)

(d) Emergency medications and equipment are available in immediate area. Crash carts and anaphylactic kits are available in all clinic areas.

(e) Patients receiving chemotherapy are given instructions on side effects and chemo precautions relating to themselves, their family and the community.

(f) MSDS information is available and current and spill kits are available for hazardous material clean up.

(g) Scheduled preventative maintenance of equipment through Clinical Engineering Services is up to date and includes proper tagging of equipment

(h) The nurse will assess, intervene and document safety needs of a patient on an individual basis. Family and sitters are instructed on safety needs and are cautioned to remain with the patient.

(i) Information is posted in all waiting areas instructing patients on how to receive immediate attention if required.

(j) Waiting areas will be monitored at assigned intervals.

C. The patient can expect that his/her comfort, rest and pain alleviation needs are identified and supported.

V. Patient Education/Discharge Planning:

A. The patient/family can expect education towards self-care and/or adaptation to their holistic well-being.

1) Patient educational needs are assessed at each visit.

2) Patient education is provided based upon identified needs and is documented.

3) All teaching is documented by all health care providers and is accessible through the Interdisciplinary

Patient/Family Education Record.

4) All new patients are referred to Health Educators. Follow-up patients are referred as needed.

B. The patient/family can expect that an individualized discharge plan is assessed, established and

implemented.

1) High Risk Screening will be completed to identify any ongoing health care needs. Referrals are made by

physicians.

2) Visit Discharge Plan is completed at each visit.

3) Discharge planning demonstrates a multidisciplinary collaboration including necessary referrals.

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